Beyond Just Therapy: Why Supportive Parents are Key to Helping Kids with Depression and Anxiety

By Andy Anderson

When it comes to helping children and teenagers struggling with depression and anxiety, parents often feel lost and unsure how to support their kids (e.g., Weisz et al., 2006). While therapy is a crucial resource, a growing body of research suggests that a robust support system at home goes a long way in the journey toward recovery (e.g., Weisz et al., 2006). This is where parent training programs offer valuable tools and strategies to empower parents in their supportive role.

Understanding the Bigger Picture:

Depression and anxiety in young people are not simply individual struggles. Researchers like Cicchetti and Toth (1998) emphasize the intricate interplay of biological, psychological, and social factors. Imagine these factors as a web – individual vulnerabilities, family dynamics, and environmental stressors are all interconnected. Recognizing this complexity is crucial to finding practical solutions (Sander & McCarty, 2005).

Beyond Medication and Therapy:

Traditional treatments like therapy and medication, as outlined in Birmaher and Brent's (2007) work, undoubtedly play a vital role in addressing depression and anxiety in youth. However, research by Sander and McCarty (2005) highlights the significant impact of family dynamics on the healing process. Parental depression and negative behaviors can significantly impact a child's mental health, as highlighted by Lovejoy et al. (2000).

Empowering Parents, Empowering Kids:

Enter parent training programs, offering a crucial bridge between traditional therapy and the home environment. Two such programs with distinct approaches are:

  • Supportive Parenting for Anxious Childhood Emotions (SPACE), developed by Dr. Eli Lebowitz (Lebowitz et al., 2020a).
  • Behavioral Parent Training (BPT), a broader program initially developed for conduct problems (Barkley, 2016).
  • Reducing accommodation: Parents often engage in "accommodation" behaviors, unintentionally reinforcing their child's anxiety by avoiding situations or activities that trigger their fears. SPACE teaches parents how to gradually reduce these accommodations, encouraging their children to confront their anxieties in a safe and supportive way (Lebowitz, 2019).
  • Building emotional connection and validation: Parents learn to actively listen to their child's anxieties without judgment and provide emotional support and validation. This fosters a trusting and supportive environment where children feel comfortable expressing their emotions without fear of criticism (Lebowitz, 2019).
  • Developing practical communication skills: SPACE equips parents with effective communication skills to express empathy and understanding while setting clear expectations and boundaries. This helps children learn healthy coping mechanisms and develop emotional regulation skills (Lebowitz, 2019).
  • Research-supported: Studies, including one by Lebowitz et al. (2020a), demonstrate SPACE to be as effective as traditional cognitive-behavioral therapy (CBT) in treating childhood anxiety.
  • Empowers parents: By equipping parents with the necessary skills and knowledge, SPACE empowers them to become active partners in their child's journey toward overcoming anxiety (Lebowitz et al., 2020a).
  • Improves family dynamics: By addressing family communication and reducing parental accommodation, SPACE can improve overall family dynamics and create a more supportive environment for all family members (Lebowitz et al., 2020a).
  • Complements other therapies: SPACE can be used as a standalone program or complement different therapeutic approaches, providing additional support and reinforcement for positive behavioral changes (Lebowitz et al., 2020a).
  • Depression: BPT can play a valuable role in supporting children and adolescents struggling with depression by indirectly influencing family dynamics, behavior management, and emotional well-being (Eckshtain et al., 2015).
  • Anxiety Disorders: Studies suggest that BPT can be effective in reducing anxiety symptoms in children, particularly when combined with other therapies like CBT (e.g., Weisz et al., 2011).
  • Eating Disorders: BPT can improve family communication and support healthy eating habits in children and adolescents struggling with eating disorders (Lock et al., 2010).
  • Equipping parents with skills: BPT programs like those outlined in Your Defiant Child (Barkley & Benton, 2013) and Your Defiant Teen (Barkley & Robin, 2013) equip parents with specific skills, such as setting clear expectations, providing positive reinforcement and using effective communication techniques (Forgatch, Patterson, & Friend, 2017).
  • Focus on positive reinforcement: BPT programs like Raising Cooperative Kids (Forgatch, Patterson, & Friend, 2017) and The Kazdin Method for Parenting the Defiant Child (Kazdin & Rotella, 2009) highlight the importance of praising desired behaviors to encourage positive change (Kazdin & Rotella, 2009).
  • Addressing parent stress and emotions: BPT programs acknowledge the impact of parental stress and emotions on child behavior and equip parents with strategies for managing their own emotional well-being, creating a calmer and more supportive environment for their children (Forgatch, Patterson, & Friend, 2017).
  • Reduced family conflict: BPT teaches parents positive communication and conflict resolution skills, leading to a calmer and less stressful home environment. This reduction in conflict can indirectly contribute to alleviating depressive symptoms in children and adolescents who may be particularly sensitive to family discord (Oregon Social Learning Center, n.d.).
  • Improved emotional regulation: By equipping parents with strategies to manage their children's challenging behaviors, BPT can lead to a more predictable and consistent environment. This sense of stability can contribute to improved emotional regulation in children, potentially reducing the emotional dysregulation that often accompanies depression (Oregon Social Learning Center, n.d.).
  • Enhanced self-esteem: BPT emphasizes positive reinforcement for desired behaviors. By receiving regular praise and encouragement, children experience an increase in self-esteem and feelings of competence, which can positively impact mood and motivation, both crucial factors in overcoming depression (Oregon Social Learning Center, n.d.).
  • Reduced caregiver stress: When children exhibit challenging behaviors, it can be incredibly stressful for caregivers. BPT empowers them with strategies to manage these behaviors effectively, reducing stress and improving emotional well-being for both parents and children. This, in turn, can create a more positive and supportive environment for children struggling with depression (Oregon Social Learning Center, n.d.).
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SPACE: Building a Supportive Environment for Anxiety Recovery:

SPACE takes a unique approach to treating childhood anxiety. Unlike traditional therapies that directly target the child's behavior, SPACE empowers parents to become active partners in their child's recovery by cultivating a supportive and nurturing environment. This approach acknowledges the significant influence of parental responses on a child's anxiety levels (Lebowitz et al., 2020a).

Fundamental principles of SPACE:

Benefits of incorporating SPACE:

Behavioral Parent Training (BPT): Equipping Parents with a Toolkit

While initially designed to address conduct problems in children and adolescents (Barkley, 2016), BPT has shown promise in treating a more comprehensive range of disorders, including:

·         Attention Deficit Hyperactivity Disorder (ADHD): BPT equips parents with skills to manage challenging behaviors associated with ADHD, such as hyperactivity and difficulty following instructions (Kazdin, 2013).

Key BPT principles:

How does BPT help children and teens recover from depression? Indirect effects on depression:

It's important to note:

BPT is not a direct treatment for depression. It should not be used as a substitute for evidence-based therapies like cognitive-behavioral therapy (CBT) or medication, which are crucial for addressing the core symptoms of depression (Birmaher & Brent, 2007). The effectiveness of BPT in supporting a child's depression recovery can vary depending on the severity of the depression and the presence of other co-occurring mental health conditions (Sander & McCarty, 2005).

While BPT is not a direct treatment for depression, it can play a valuable role in supporting children and adolescents struggling with the condition by indirectly influencing family dynamics, behavior management, and emotional well-being. It is essential to seek professional guidance from a qualified mental health professional to determine the most appropriate treatment approach for a child's specific needs (American Academy of Child and Adolescent Psychiatry, n.d.).

A Multifaceted Approach:

While BPT, SPACE, and other parent training programs offer promising avenues, it's important to remember that every child and family is unique. Addressing depression and anxiety in youth often requires a multifaceted approach. This may include combining individual therapy with parent training, medication, and other evidence-based interventions tailored to the specific needs of each child and family (American Academy of Child and Adolescent Psychiatry, n.d.).

Conclusion:

Equipping parents with knowledge and skills through various interventions like BPT and parent training programs like SPACE empowers them to become active partners in their child's recovery. This, combined with other evidence-based therapies, can foster a supportive and nurturing environment conducive to healing, ultimately improving youth mental health outcomes.

**It is crucial to seek professional guidance from a qualified mental health professional to explore the various support options available and create a personalized treatment plan




References

Barkley, R. A. (2016). Opinion: A response to the CDC press conference on behavioral parent training and treating ADHD in young children. The ADHD Report, 24(4), 11-11,16. https://doi.org/10.1521/adhd.2016.24.4.11

Barkley, R. A., & Benton, C. M. (2013). Your Defiant Child: Eight Steps to Better Behavior. Guilford Press.

Barkley, R. A., & Robin, A. L. (2013). Your Defiant Teen: 10 Steps to Resolve Conflict and Rebuild Your Relationship. Guilford Publications.

Birmaher, B., & Brent, D. (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(11), 1503–1526. https://doi.org/10.1097/chi.0b013e318145ae1c

Cicchetti, D., & Toth, S. L. (1998). The development of depression in children and adolescents. American Psychologist, 53(2), 221–241. https://doi.org/10.1037//0003-066x.53.2.221

Eckshtain, D., Kuppens, S., & Weisz, J. R. (2015). Amelioration of child depression through behavioral parent training: A preliminary study. Journal of Clinical Child & Adolescent Psychology, 46(4), 611–618. https://doi.org/10.1080/15374416.2015.1050722

Erratum. (2017). Journal of the American Academy of Child & Adolescent Psychiatry, 56(9), 800. https://doi.org/10.1016/j.jaac.2017.07.004

Forgatch, M. S., Patterson, G. R., & Friend, T. (2017). Raising cooperative kids: Proven practices for a connected, happy family. Red Wheel/Weiser.

Kazdin, A. E., & Rotella, C. (2009). The Kazdin method for parenting the defiant child: With no pills, no therapy, no contest of wills. Houghton Mifflin Harcourt.

Lebowitz, E. R. (n.d.). SPACE. SPACE Treatment. https://www.spacetreatment.net/

Lebowitz, E. R. (2019). Addressing accommodation. In Addressing Parental Accommodation When Treating Anxiety In Children (pp. 59–68). Oxford University Press. http://dx.doi.org/10.1093/med-psych/9780190869984.003.0006

Lebowitz, E. R. (2020). Breaking free of child anxiety and OCD. Oxford University Press. http://dx.doi.org/10.1093/med-psych/9780190883522.001.0001

Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020a). Parent-Based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: A randomized noninferiority study of supportive parenting for anxious childhood emotions. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 362–372. https://doi.org/10.1016/j.jaac.2019.02.014

Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020b). Parent-Based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: A randomized noninferiority study of supportive parenting for anxious childhood emotions. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 362–372. https://doi.org/10.1016/j.jaac.2019.02.014

Lebowitz, E. R., & Omer, H. (2013). Treating childhood and adolescent anxiety. Wiley. http://dx.doi.org/10.1002/9781118589366

Lovejoy, M. C., Graczyk, P. A., O'Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior. Clinical Psychology Review, 20(5), 561–592. https://doi.org/10.1016/s0272-7358(98)00100-7

Oregon Social Learning Center. (n.d.). Oregon Social Learning Center. Retrieved February 28, 2024, from https://www.oslc.org/

Sander, J. B., & McCarty, C. A. (2005). Youth depression in the family context: Familial risk factors and models of treatment. Clinical Child and Family Psychology Review, 8(3), 203–219. https://doi.org/10.1007/s10567-005-6666-3

Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin, 132(1), 132–149. https://doi.org/10.1037/0033-2909.132.1.132

 

 

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